At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

A Brief Overview
Follows established processes in supporting accurate and timely enrollment processing as well as customer service and issue resolution. Focuses on compliance with regulations and legislative guidelines. Maintains a culture of excellence and accountability delivery of established metrics. Able to adjust and be flexible to meet deadlines. Collaborates with internal business partners such as Case Installation, Billing, and Sales to ensure successful customer experience.

What you will do

• Evaluates and assesses eligibility criteria for healthcare programs and benefits by analyzing member data, documentation, and applicable regulations to determine eligibility for enrollment and benefits.
• Checks the accuracy and completeness of member eligibility information through various sources, such as databases, enrollment forms, and system validations.
• Administers member enrollments, changes, and terminations in accordance with established procedures and timelines.
• Ensures compliance with relevant laws, regulations, and policies governing eligibility determinations and enrollment processes.
• Conducts quality checks and audits on eligibility processes to ensure accuracy, compliance, and adherence to established standards.
• Handles and resolves eligibility-related issues or discrepancies raised by members, providers, or internal stakeholders.
• Communicates eligibility guidelines, requirements, and updates to ensure accurate and efficient eligibility determination to internal stakeholders.

For this role you will need Minimum Requirements

• 1+ year work experience
• Problem solving skills
• This is a remote work model. You will be expected to have a dedicated workspace in your home which can be secured while away from your desk and at the end of the day.
• Communicates effectively with team members, management and cross- functional business partners.
• Possesses strong organizational skills.
• Demonstrates attention to detail, and the ability to manage multiple competing priorities.

Preferred Qualifications

• Previous/current Operations experience.
• Previous eligibility/enrollment experience.
• Establishes a clear vision aligned with company values; motivates others to balance customer needs and business success.
• Works effectively in ambiguous situations.
  

Education

• College degree preferred.
• High School Diploma or G.E.D. Equivalent.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.